A new bicortical tibial fixation technique in anterior cruciate ligament reconstruction with quadruple hamstring graft

Abstract

We report a prospective series of 101 patients receiving a four-strand semitendinosus-gracilis autograft for anterior cruciate ligament reconstruction using a new bicortical tibial fixation technique with bioabsorbable interference screws. Patients (average age 32 years) were operated on between November 1997 and Mai 1998, and follow-up was at least 12 months postoperatively. The evaluation consisted of history, clinical examination, IKDC score, Cincinnati Knee Score, KT-1000 testing, standardized radiography and magnetic resonance imaging. One hundred patients were available for follow-up. There were two traumatic reruptures 6 and 11 months postoperatively. By IKDC score 87 patients were in groups A and B, 12 in group C, and 2 with a rerupture in group D. Mean Cincinnati Knee Score was 82 (range 46-100), KT-1000 manual maximum at follow-up showed an average difference of 1.7 mm between the sides. Full extension was rapidly achieved in all cases, and flexion averaged 135 degrees . Considering the enlargement caused by the bioabsorbable interference screws, the incidence of tunnel widening was 6.6% on the femoral side and 1.7% on the tibial side. Tunnel widening did not affect the clinical results. Three patients experienced an effusion after more than 6 months postoperatively. There was one infection, which settled without functional impairment after early arthroscopic lavage and intravenous antibiotics. Otherwise no complications occurred. The described technique for anterior cruciate ligament reconstruction combines the advantage of anatomical graft position with sufficient graft fixation. A short intra-articular graft construct with a strong tendon to bone interface was created. Clinically, 87% of patients had a normal or nearly normal IKDC score at follow-up. Magnetic resonance imaging revealed a considerable increase in tunnel area caused by the insertion of the interference screws. On the other hand, the development of a "fibrous interzone" between the graft and the bone tunnel was prevented in most cases. At short-term follow-up the bicortical tibial fixation proved to be efficient even with an aggressive rehabilitation program.

ACL reconstruction and the implication of its tibial attachment for stability of the joint: anthropometric and biomechanical study

“…Various surgical techniques have been suggested, using autografts (patellar, semitendinosus, gracilis), allografts, synthetic materials, or combinations of these [3,4,10,13,15,16,18,21,23]. Postoperatively, all previously reported surgical techniques reveal an incidence of positive Noulis-Trillat-Lachmann test [13,15,18,26].…”

Biodegradation of a magnesium alloy implant in the intercondylar femoral notch showed an appropriate response to the synovial membrane in a rabbit model in vivo

“…Degradable screws manufactured of polymers such as poly-L-lactide or poly-DL-lactide-co-glycolide have been used clinically, but have displayed insufficient mechanical stability and the degradation products can produce adverse effects. 2 Intraoperative and postoperative implant breakages of a resorbable polylactid acid screw have been reported, 3,4 as well as implant displacement into the joint, 5,6 joint swelling, 7 and tunnel widening around the implant. 8 In recent years, magnesium alloys have been investigated intensively as an alternative biodegradable material for orthopedic implants.…”

Thumb Carpometacarpal Suspension Arthroplasty Using Interference Screw Fixation: Surgical Technique and Clinical Results

“…Screw fracture upon insertion has an incidence between 0.2% and 7% in the ACL literature, 32,35 and late fracture has occurred up to 3 years after surgery. 36,37 Intra-articular screw migration 38,39 and prolonged joint effusions 31,39 have also been reported. We demonstrate no revisions at an average of 19 months, with good functional outcome, minimal pain, and range of motion and strength that are no different from the contralateral side (with the exception of lateral key pinch strength) using the described technique.…”